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Polysomnograph

Assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions

Sleep hygiene

Psychological treatment for insomnia that teaches clients to recognize and eliminate environmental factors to sleep. These include the use of nicotine, caffeine, certain medications, and alcohol, as well as ill-timed exercise.

Criterion gender bias

Possibility that gender differences in the reported prevalence or diagnosis of certain diagnostic categories may be due to prejudice in the defining criteria for the disorder.

Assessment gender bias

Possibility that gender differences in the reported prevalence or diagnosis of certain diagnostic categories may be due to prejudice in the assessment measures of the diagnostician or the ways they are used

Psychopaths engage in dangerous or illicit behavior to stimulate the under-aroused cerebral cortex in their brains
Cortical immaturity – behavior and arousal levels of psychopaths result from incomplete development of the cerebral cortex
Fearlessness – Psychopaths are less prone to fear and thus less inhibited from dangerous or illicit activities

Cortical immaturity – behavior and arousal levels of psychopaths result from incomplete development of the cerebral cortex

Fearlessness – Psychopaths are less prone to fear and thus less inhibited from dangerous or illicit activities

Complex PTSD

John Briere proposed that 80-90% of women diagnosed with Borderline Personality Disorder (BPD) have “complex Post-Traumatic Stress Disorder.” These women, after experiencing years of traumatic sexual abuse, interact with the world abnormally because their “ego has been violated,” and boundaries between love and sex have been blurred.

Dual diagnosis

When someone is diagnosed with two Axis I disorders. This usually occurs with substance abuse disorders.

Substance abuse

When a substance disrupts one’s education, job, or relationships with others, puts them in physically dangerous situations (e.g. being under the influence and driving), and if a person has substance-related legal problems

Substance dependence

Two views:
1) A person is physiologically dependent on a substance, requires greater and greater amounts of the substance to experience the same effect (tolerance), and will respond physically in a negative way when the substance is no longer ingested
2) A person exhibits “drug seeking behaviors” as indications of dependence, e.g. stealing to buy drugs, and likely will resume drug use after a period of abstinence

Tolerance

Needs for increased amounts of a substance to achieve the desired effect, and a diminished effect with continued use of the same amount

Withdrawal

Severely negative physiological reaction to removal of a psychoactive substance, which can be alleviated by the same or a similar substance

Parens Patriae

Literally, “state or country as the parent.” The state applies parens patriae power in circumstances in which citizens are not likely to act in their own best interest, for example to assume custody of children who have no living parent. Similarly, it is used to commit individuals with severe mental illness to health facilities when it is believed that they might be harmed because they are unable to secure the basic necessities of life, such as food and shelter (grave disability), or because they do not recognize their need for treatment. The state acts as a surrogate parent, presumably in the best interests of a person who needs help.

Deinstitutionalization

The systematic movement of people with severe mental illness out of institutions to:
1) close the large state mental hospitals, and
2) create a network of community mental health centers where the released individuals could be treated
Failures of goal (2) led to mass transinstitutionalization.

Transinstitutionalization

Movement of people with severe mental illness from large psychiatric hospitals to nursing homes, or other group residences, including jails and prisons

Duty to warn

Mental health professionals’ responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened. This is IN ADDITION to notifying appropriate authorities.

Know the similarities and differences in the different eating disorders.

Bulimia Nervosa – out of control binges followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge the food
Anorexia Nervosa – the person eats nothing beyond minimal amounts of food, causing extremely (and sometimes dangerously) low weights.
Binge eating disorder – individual binge repeatedly and find it distressing
Night eating syndrome – almost 1/3 of an individual’s calories are consumed late at night

There are three factors that separate anorexia from bulimia:

1)Anorexics are underweight, whereas bulimics are much less “successful”
2)Anorexics have genuine FEAR of weight gain (bulimics are concerned as well, but not necessarily fearful).
3)Anorexics are proud of the control they have over their weight.

Eating disorders are characterized by

Eating dysfunction and have the highest cultural specificity, with no effective biological treatments.
Anxiety and mood disorders are often co-morbid with anorexia and bulimia.

What is the chief motivating factor in both anorexia and bulimia?

A morbid fear of gaining weight and losing control over eating

What is the most significant feature of bulimia?

The most significant feature is the binge eating itself, since there are both purging and non-purging types of the disorder. There is also a sense of lack of control over eating during the episode. Binge eating is associated with an inappropriate compensatory behavior, usually purging, but often misuse of laxatives or fasting.

What is the most significant feature of anorexia?

Anorexics are successful at losing extreme amounts of weight. They are characterized by being less than 85% of expected weight. They also have an intense fear or gaining weight, and they have distorted images of their own body shape.

Western ideals of looking thin. Usually young females in middle- to upper-class, competitive environments, where self-worth, happiness, and success are determined by body measurements and fat percentages.

What percent of people with anorexia die as a result of suicide?

10% die from suicides, with 20% total dying from their disease (including suicides).

What is known about the mortality rate from eating disorders?

They have highest mortality rate for any psychological disorder, including depression

What are the key symptoms of binge eating disorder?

Marked distress due to binge eating, but NO compensatory behaviors. Twenty percent of obese individuals in weight-loss programs and 50% of bariatric surgery candidates engage in binge-eating behaviors. Half try dieting before bingeing, while half attempt to diet after bingeing.

Is obesity a mental disorder? What might be the disorder closest to it?

Obesity is not formally classified as a mental disorder. The disorder closest to it is binge eating disorder

What does the typical family of a person with anorexia look like?

Successful, hard-driving, concerned about external appearances, and eager to maintain harmony, often by denying or ignoring conflicts or negative feelings.

What interventions have been shown to be most promising for eating disorders?

Cognitive behavior therapy (CBT) and family therapy. In anorexia, the first immediate treatment is weight gain. Then, CBT and family therapy have been shown to be effective. CBT is the preferred treatment for bulimia. CBT and self-help manuals are most effective for binge-eating disorder.

What are the components of family therapy in treating an eating disorder?

Particularly with young girls suffering from anorexia, family therapy seems to be effective. Every effort is made to include the family in therapy. First, negative and dysfunctional communications regarding food and eating must be eliminated. Second, attitudes towards body shape and image distortion are discussed at length.

What are the two types of sleep disorders?

Dysomnias - difficulties getting enough sleep, problems with sleeping when you want to, and complaints about the quality of sleep.
Parasomnias – abnormal behavior or physiological events that occur during sleep, such as nightmares and sleepwalking.

Primary insomnia

initiating or maintaining sleep, or sleep that is not restorative

Primary hypersomnia

complaint of excessive sleepiness that is displayed as either prolonged sleep episodes or daytime sleep episodes.

Repeated awakenings with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. Awakenings generally occur during the second half of the sleep period

Sleep Terror Disorder

Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of major sleep episode and beginning with a panicky scream.

Sleepwalking Disorder

Repeated episodes of arising from bed during sleep and walking about usually occurring during the first third of the major sleep episode.

What is primary insomnia?

Difficulty in initiating, maintaining, or gaining from sleep; primary means not related to other medical or psychological problems. Often maintained by ABC – affect, behavior, cognition.

This disorder is most associated with the suprachiasmatic nucleus in the hypothalamus.

How are night terrors different from nightmares?

After being awakened, children do not remember night terrors, while they do remember nightmares. Also, nightmares occur during REM sleep, whereas sleep terrors, along with sleepwalking and nocturnal eating disorder, occur during non-REM sleep.

What is the problem with taking benzodiazepines for dyssomnias?

1)Insomnia rebound when you stop taking meds (you get less sleep than before you started
2)REM rebound (best case scenario) – your first stage of sleep is REM
3)People can become dependent

What are stimulus control procedures, and for what type of disorders are they used?

In stimulus control procedures, patients are instructed only to use the bedroom for sleep and sex, and not for any other work or anxiety-provoking activities

Where on the 5 axes are personality disorders coded?

On Axis II, because they’re inflexible and hopeless (same axis as mental retardation).

Classes of personality disorders, and which disorders belong to which group?

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

Schizoid PD

A pervasive pattern of detachment from social relationships and a restricted range of emotions in interpersonal settings

Schizotypal PD

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior

Antisocial PD

A pervasive pattern of disregard for and violation of the rights of others

Borderline PD

A pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses

Histrionic PD

A pervasive pattern of excessive emotion and attention seeking

Narcissistic PD

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy

Avoidant PD

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Dependent PD

A pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation

Obsessive-compulsive PD

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency

What has research revealed about antisocial personality disorder and the behavioral inhibition system?

The behavioral inhibition system (BIS) is responsible for our ability to stop or slow down when we are faced with impending punishment, nonreward, or novel situations, which leads to anxiety and frustration. The reward system is responsible for our approach behavior.

Research with ASPD has shown an imbalance between BIS and reward system which may make the fear and anxiety produced by the BIS less apparent and the positive feelings associated with the reward systems. This could explain why psychopaths aren’t anxious about committing the acts that characterize their behavior.

What is the 5-factor model of personality, and what are the 5 factors studied?
The Big Five: people can be rated on a series of 5 personality dimensions, and the combinations of the five components are what makes people different. People are rated high, low, or in-between on the five factors, which are:

What has recent research revealed about the prevalence of homosexuality in western countries, and is this consistent with the Kinsey report?

That the 10% stat of the Kinsey report is probably closer to 2-3% in men and 5% in women in terms of engaging in homosexual acts, and 1% who engage exclusively in homosexual acts

What do we know about sexual activity in older age?

Sexual behavior can continue well into old age. Fifty percent of men and 36% of women 75-79 are sexually active (the discrepancy is probably due to age differences in relationships and lack of partners for women in the upper seventies).

Know the different gender differences related to sexual behavior.

1)Much higher percentage of men masturbate than women (frequency is about 3X greater among men who masturbate than women, also)
2)Men express a far more permissive attitude towards casual sex than women
3)No gender differences in attitudes about homosexuality or masturbation
4)Women desire demonstrations of love and intimacy during sex, while men are more interested in the arousal aspects
5)Women often hold embarrassed, conservative, or self-conscious schema about sex (Barbara Anderson), whereas men’s self-concept is more dominated by power, independence, and aggression
6)Women emphasize committed relationships
7)Women’s beliefs are more “plastic,” in that they are shaped by cultural, social, and situational factors. For example, women are more likely to change sexual orientation
8)Men have sex to feel close to a partner, whereas women have sex because they feel close to their partner

Was homosexuality ever considered a mental disorder in the United States? Is it so considered now?

Yes: No

What is the definition of gender identity disorder?

Gender Identity Disorder (transsexualism) is present if a person’s physical gender is inconsistent with the person’s sense of identity. This disorder is independent of sexual arousal patterns (straight and gay people can have it), and is separate from transvestic fetishism and intersexed (hermaphroditic) individuals. In some cultures (but not the West), they are accorded the status of shaman or “seer.”

What is a sexual fetish?

Sexual attraction to non-living objects.

What is a paraphilia, and how is it different from a sexual dysfunction?

Paraphilias are sexual disorders and deviations in which sexual arousal occurs almost exclusively in the context of inappropriate objects or individuals. Patients must have either acted on their urges or be severely distreased by them. Sexual dysfunction occurs when the client finds it difficult to function adequately WHILE having sex. With both paraphilias and sexual dysfunction, clients normally present with more than one (although one is usually dominant).

What is the best predictor of sexual distress among women who are diagnosed with a sexual dysfunction?

Deficits in general emotional well-being or emotional relationships with the partner during sexual relations

Sexual dysfunction treatment

Human Sexual Inadequacy, by William Masters and Virginia Johnson revolutionized sex therapy by providing a therapeutic program. It has been adapted by many, but still includes altering myths, increasing communication, and reducing performance-based anxiety. Sensate focus and nondemand pleasuring includes nongenital pleasuring, then genital pleasuring (with ban on orgasm), arousal, and then intercourse (starting with the beginnings of penetration). Sex therapists also use the squeeze technique for premature ejaculation, training in masturbatory procedures for female orgasmic disorder, and reeducation and cognitive restructuring for low sexual desire.

For vaginismus, a larger and large dilator is inserted into the vagina at the woman’s own pace.

For paraphilias treament

Behavior therapies are used to change the associations and context from arousing and pleasurable to neutral.

Covert sensitization involves sexually arousing images associated with the consequences of the behavior that brought the patient to treatment in the first place (in imagination, dangerous consequences can be associated directly with unwanted behavior). Orgasmic conditioning instructs patients to masturbate to their usual fantasies but substitute more desirable ones just before ejaculation. In relapse prevention, patients are taught to recognize the early signs of temptation and to institute a variety of self-control procedures before their urges become too strong.

What two groups of people have the lowest success rate in treating sexual disorders?

Men who rape/ pedophiles and individuals with multiple paraphilias

What is safest in defining rape?

To classify it as an assault by a person whose sexual arousal patterns are not paraphilic.

What is the definition of substance-related disorders?

Range of problems associated with the use and abuse of drugs such as alcohol, cocaine, heroin, and other substances people use to alter the way they think, feel, and behave. These are extremely costly in human and financial terms.

What are 2 very common substances used by students?

Alcohol and caffeine

What are the different classes of substance that can cause substance-related disorders?

What is the typical profile of a person with alcohol-related disorder?

Caucasian-American male college student

What are some of the long term effects of chronic alcohol use, and what is the DSM disorder associated with it?

Long term use can lead to the DSM-IV classified Korsakoff-Wernicke’s syndrome

Why do we say that alcohol has a ‘paradoxical’ effect?

Because although alcohol is a depressant, its initial effect is an apparent stimulant. This is because when it depresses the CNS, it also depresses the frontal lobe, thus leading to a loss of control and “feeling” stimulated. Also, inhibition of GABA system leads to feelings of stimulation.

What is known as the ‘date rape drug’, and how does it work?

Ruhypnol; sedative – results in intoxication and blackouts. It is used as a date rape drug because it is impossible to detect (colorless, odorless, tasteless)

Know the different types of impulse control disorders.

Intermittent explosive disorder – people act on aggressive impulses that result in very serious assaults or destruction of property
2)Kleptomania – a recurrent failure to resist urges to steal things that are not needed
3)Pyromania – irresistible urges to set fires
4)Pathological gambling – gambling impulses, coupled with tolerance, and withdrawal symptoms, such as restlessness and irritability.
5)Trichotillomania – the urge to pull out one’s own hair

What is trichotillomania, and whom does it hurt most?

The urge to pull one’s own hair from anywhere on the body including the scalp, eyebrows, and arms. It most hurts the person with trichotillomania.

Is the term ‘insanity’ a psychological term, and if not, what type of term is it?

Insanity is neither a psychological nor medical concept. It is a legal concept.

M’Naughten Insanity Defense

a person is not responsible if they
a.Do not know what they are doing, or
b.Do not know that it’s wrong

Durham Insality Defense

A person is not responsible for criminal behavior if the act was caused by a mental disease

ALI RULE

A person is not responsible for criminal behavior if they are lacking in cognitive ability to appreciate the criminality of the act.

A person must either not be able to distinguish right form wrong or Be incapable of self-control to be shielded from legal consequences
c.Also provided provisions for “Diminished capacity,” in which criminal intent (mens rea)) is diminished
d.Irresistible impulses

Insanity Reform Act – after Hinkley –

No responsible for criminal behavior if they do not know that what they are doing is wrong- made the use of the insanity defense more difficult

What proportion of cases heard by the court use the insanity defense? How often is the defense successful?

0.9% of indictees use the insanity defense, of which 26% of those receive an acquittal

How often is the defense successful?
0.9% of indictees use the insanity defense, of which 26% of those receive an acquittal
What do we know about the success of deinstitutionalization?

Deinstitutionalization is considered a failure because it led to mass transinstitutionalization

Informed consent

Ethical requirement whereby research subjects agree to participate in a research study only after they receive full disclosure about the nature of the study and their own role in it

Dual Relationships

any extra-professional relationship that a therapist and patient might have. An example is bartering for services (typical in rural communities). Generally, it’s discouraged.

Emerging profile of a therapist most likely to engage in sexual relations with a client –

Caucasian males who have been in practice for over 10 years and feel “socially isolated,” due to lack of social network.

Know the different types of impulse control disorders.

Intermittent explosive disorder – people act on aggressive impulses that result in very serious assaults or destruction of property
2)Kleptomania – a recurrent failure to resist urges to steal things that are not needed
3)Pyromania – irresistible urges to set fires
4)Pathological gambling – gambling impulses, coupled with tolerance, and withdrawal symptoms, such as restlessness and irritability.
5)Trichotillomania – the urge to pull out one’s own hair

What is trichotillomania, and whom does it hurt most?

The urge to pull one’s own hair from anywhere on the body including the scalp, eyebrows, and arms. It most hurts the person with trichotillomania.

Is the term ‘insanity’ a psychological term, and if not, what type of term is it?

Insanity is neither a psychological nor medical concept. It is a legal concept.

M’Naughten Insanity Defense

a person is not responsible if they
a.Do not know what they are doing, or
b.Do not know that it’s wrong

Durham Insality Defense

A person is not responsible for criminal behavior if the act was caused by a mental disease

ALI RULE

A person is not responsible for criminal behavior if they are lacking in cognitive ability to appreciate the criminality of the act.

A person must either not be able to distinguish right form wrong or Be incapable of self-control to be shielded from legal consequences
c.Also provided provisions for “Diminished capacity,” in which criminal intent (mens rea)) is diminished
d.Irresistible impulses

Insanity Reform Act – after Hinkley –

No responsible for criminal behavior if they do not know that what they are doing is wrong- made the use of the insanity defense more difficult

What proportion of cases heard by the court use the insanity defense? How often is the defense successful?

0.9% of indictees use the insanity defense, of which 26% of those receive an acquittal

How often is the defense successful?
0.9% of indictees use the insanity defense, of which 26% of those receive an acquittal
What do we know about the success of deinstitutionalization?

Deinstitutionalization is considered a failure because it led to mass transinstitutionalization

Informed consent

Ethical requirement whereby research subjects agree to participate in a research study only after they receive full disclosure about the nature of the study and their own role in it

Dual Relationships

any extra-professional relationship that a therapist and patient might have. An example is bartering for services (typical in rural communities). Generally, it’s discouraged.